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Date mReport#5021 n 2/18/2015 2:20:26PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Pagel <br /> Run by ; Facility Information as of 2/18/2015 <br /> Record Selection Criteria: Facility ID FA0011047 <br /> _w ake changes/corrections in RED Ink. <br /> lu ■lw)r INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for is owner : 1 SSN/Fed Tax ID <br /> Owner ID OW0009047 Case Number: H09212 New Owner ID <br /> Owner Name TEREX UTILITIES INC <br /> owner DBA TEREX UTILITIES INC <br /> Owner Address 200 NYALA FARMS RD <br /> WESTPORT, CT 06880-6261 <br /> Home Phone 203-222-7170 <br /> Work/Business Phone 425-881-1800 <br /> Mailing Address 200 Nyala Farms RD. <br /> Westport, CT 06880-6261 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0011047 10184063 <br /> Facility Name UTILITIES INC <br /> 2610 L <br /> Location 2610 YCOMING ST <br /> STOCKTON, CA 95206 <br /> Phone 800-536-1800 x <br /> Mailing Address 18465 NE ST <br /> REDMOND, WA 98052 <br /> care of Terex Equipment Services <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 17929034 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Robert Morris <br /> Title <br /> Day Phone 209-242-7150 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0018047 New Account ID: <br /> Mail Invoices to Facility � Mail Invoices to: Owner / Facility / Account <br /> Account Name TEREX UTILITIES INC (Circle One) <br /> Account Balance as of 2/18/2015: $2,232.00 <br /> (Circle One) <br /> Transfer to Activellnactie <br /> ProgranvElement and Description Racord ID Employee ID and Name Status New Owner/ Delete <br /> 1921 -HMBP-Regular-Primary Location PRO520632 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513335 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2247-RCRA GEN 5<25 TONS PR0518016 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO511047 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO536443 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO536330 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT I,the undersigned owner,operator or agent of same,acknowledge that all site,enwor project speck,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this forth. Ialso certify that all operations will be Performed In accordance with all applicable Ordinance Codes anaor Standards and State anew <br /> Federal Laws. p,� / <br /> APPLICANTS SIGNATURE: Ili `A t`L_ Date 1�1� ( V��-- r` "D Date �/ 1-7/ l <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Receiv <br /> RENS: Date_/ / Account out: Date —2- / 2-7/�_ <br /> COMMENTS: <br />